Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Tuesday, August 14, 2007

In a recent post, Daniel Carlat apologized to Charles Nemeroff for nicknaming him "Bling Bling" in a prior post. So what? Who cares? Well, I think we need to take a look at what behavior requires an apology and what does not. I'm not saying I have the answers, but I think the issue is quite important.

Let's look at some documented issues regarding Nemeroff:

ARISE-RD 1: Nemeroff was an author on a study (called ARISE-RD) examining the use of risperidone as an antidepressant. The study results did not demonstrate that the drug worked, especially after the authors issued a correction indicating that one of the findings in the published version of the study was incorrect (oops -- sorry that we mentioned that the drug worked; we screwed up -- it really did not work).

ARISE-RD 2: The study results were clearly not reported in full, leaving open the possibility that unfavorable data for risperidone was simply swept under the rug.

ARISE-RD 3: The study was published in a journal of which Nemeroff was the editor. Strangely, he did not report that he had a financial conflict of interest in the study, though the journal requires such relationships to be disclosed.

ARISE-RD 4: Authorship was switched around, leading one to wonder if the authorship line was an accurate reflection of who contributed significantly to the study or if it included an effort to stamp on the names of several "key opinion leaders" in order to improve the study's marketing value (1, 2 ).

I strongly encourage readers to read the linked posts above in order to plumb the depths to which this study appeared to be flawed. But there's more...

VNS: In his role of journal editor, Nemeroff again failed to disclose relevant conflicts of interest regarding a study that appeared in his journal and upon which he was an author. Read more on that tale here and here.

Mifepristone/RU-486: Nemeroff wrote an article reviewing various treatments. One treatment he mentioned was mifepristone (Corlux/RU-486). Nemeroff serves in a paid advisory role to Corcept, maker of the drug. He concluded, based upon incredibly weak evidence, in the review, that mifepristone was "very effective" in treating psychotic depression.

Lithium patch: In the same review article as mentioned above, Nemeroff mentioned that the lithium patch improved tolerability and compliance. So the patch made patients stick with treatment better and lowered the side effect burden. Oh, and Nemeroff did not cite a single source to back up these claims. Um, the entire point of a review article is to make claims and back them with sources. Nemeroff holds the patent for the lithium patch, by the way.

David Healy: According to some sources (not entirely confirmed, though I believe it), Nemeroff was part of the effort to get David Healy ousted from his position at the Univeristy of Toronto. It's a long story, worth reading about here and here. As readers of my site know, I have cited Healy's work here many times due to his close knowledge of data regarding psychiatric medications (particularly SSRI's) -- he's a good scientist with, in my mind, a very strong conscience. If Nemeroff was involved in getting Healy's position rescinded, then I say shame on him.CME and Dr. Nemeroff: Dr. Nemeroff, like many key opinion leaders, is willing to set his name on journal supplement papers which are then used for continuing medical education. Daniel Carlat has a great post about a recent CME activity, upon which Nemeroff was an author, that seemed to magically transform unfounded ideas into "science" by just adding a sprinkling of money from the sponsor, Bristol Myers Squibb. Kinda made me think of a Chia Pet for some reason. Suh-Suh-Suh-Science! to the tune of Chuh-Chuh-Chuh-Chia!

So looking at the above list of items involving Nemeroff, I ask readers: Is it okay to nickname someone "Bling Bling" or to nominate someone for a Golden Goblet award? Please chime in with a comment to let me know. Is it acceptable sarcasm or is it character assassination, or something else?

The Point: I'm not in favor of name calling, nor am I in favor of being a jerk. But where does one draw the line? Where is the line drawn between acceptable reporting on controversial and important issues and being a bully? Over at the Drug Wonks blog, there are several posts that take aim at Steve Nissen and others, often using a nastier tone than nicknaming people "Bling Bling." Plenty of mudslinging occurs in blogs and in the "old media" -- watch most of the talking heads on so-called cable "news" networks and see what I mean. How often, and to what degree, is someone allowed to use sarcasm before it becomes rude and bullying? Part of writing is entertaining one's audience, and let's face it -- sarcasm can be very entertaining. How is a blogger to be entertaining, stick to the facts, and bring important information to readers without crossing the line into being offensive? I don't know. Perhaps you do -- again, leave a comment and see if you can shed light on this issue.

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I agree, it is a tough issue. "Bling bling" is not terribly mean, and Nemeroff has probably been called worse. I suppose it's possible to get the basic point across without being insulting, which is what Dr. Posternak had emailed me about. Now, in my post today I headline it with something pretty insulting, not to mention a little profane ("commercial crap") but somehow the fact that I was quoting someone else made it more acceptable. It's a very gray area, this blogosphere!

As I continue to read some of the information shared by CL PSYCH and The Last Psychiatrist and now you, it is more and more apparent as well as disturbing to me as a care giver and lay-person to read what appears to be deterioration within the field of Psychiatry.

It’s bad enough when I read the various research studies looking for possible medical direction in order to make informed medical decisions in aiding my spouse’s cause that I come away perturbed. As I read the numerous keywords such as “may” or “believe” or “in our opinion” or “suggests” or “further research is required” etc, etc I seem to always come away without ever reading any definitive answers or conclusions. More and more I also read what appears to me to no longer be an oversight on the part of Dr. Nemeroff, in the case of the VNS matter, and that of other researchers but Nemeroff seems to demonstrate a consistent impropriety on his part.

I too believe it improper to character assassinate an individual but I have been called far worse than “Bling, bling” for my thoughts or opposing opinions. Actually it sounds more like “Ka ching, Ka ching” taking place.

I’ve expressed it here and on The Last Psychiatrist’s blog that I lay the blame at his and your door steps and that of your colleagues and associates. In my opinion the medical profession brought upon themselves the degeneration of the health care system in this country which led to the advent of HMO’s (increased profits for the company and executives and little or no care for the patient and the bitching and moaning of the clinician) and apparently the same is obviously happening in the prostitution taking place in the field of research.

It’s wonderful to have the opportunity and access to learn the goings on from these blogs but I place the responsibility of cleaning up this egregious mess and returning to the oath and ideals of your profession(s) into your hands. Cite and/or cull out the bad apples i.e. “Bling, bling” and as Liz Spikol likes to put it, ““It's not about being positive or negative -- it's about telling the truth.” Better educate your fellow practitioners and the soon to be new psych medicos.

It is time the ladies and gentlemen of your profession stepped up and put an end to this crap.

You know if you want to call crap when you see it, then do it. Blogs written by people like myself have no power in the blogosphere to change the system, but you all do. The ones that are speaking out, doctors, practioners, say what you think for ONCE and mean it, leave it there in print and call it a day. Someone has to stir the pot without fear of losing face or the golf date. Speak up, and "bling bling" ---you have got to be kidding. Who the hell is upset about being called that? Check the person off the Holiday fruitcake list.You all have better things to do than piss and moan, apologize then rip shit in week. Come on--that's for us lowly bloggers to do.Professionals of any sort speaking out and wimping out over "bling bling" ="wimp wimp".

Nemoroff deserves all the name calling he gets on some of these blogs and a lot more besides as far as I'm concerned. He's one slimy character and while some of these guys are not deliberately unethical I think there's a good chance he is. Witness his failure to disclose his ties to Vagus Nerve Stimulation device manufacturers while penning an article lauding its benefits in a journal for which he was the editor. Just how many different conflicts of interest does that represent? In fact he didn't even write the article -- it was ghostwritten -- probably by the manufacturer. See ahrp.blogspot.com for more on this (Google Charles Nemeroff). What he's done to Healy is unspeakable. He's arrogant and patronizing and would never, ever admit the folly of his ways even when the evidence is staring him blatantly in the face.

"[B]ut I place the responsibility of cleaning up this egregious mess and returning to the oath and ideals of your profession(s) into your hands. Cite and/or cull out the bad apples i.e. “Bling, bling” and as Liz Spikol likes to put it, ““It's not about being positive or negative -- it's about telling the truth.” Better educate your fellow practitioners and the soon to be new psych medicos. "

Amen, herb. I place the responsibility where it belongs as well. Amen.

@Roy Poses: Exactly the point here. If professionals have to keep "professional courtesy" while online on sometimes anonymous blogs--then why blog about it at all? I feel the point of exposing the crap behind the medical/pharma/psych world is to expose it, with truth and honesty and frankly "bling bling" is so benign, that it proves the point that the "big wigs" have far too much arrogance and probably a lot of pharma-funded dinners and freebies they don't want to lose, including money for "studies and trials".If a person such as Carlat speaks his mind and makes a few enemies as a result, it ultimately was for a worthy cause? right?It's like being a whistle blower and wanting to keep your job and circle of friends in tact. That doesnt always happen.

Walking through fire is usually done alone.

Personally, this is my suggestion for all of the professionals who blog:

Stop reading each others blogs.

Write what you want to write without hesitation, and see how good your work looks in a month.

Character assignation? He's done a fine job of it on his own through his own actions.

When caught with presenting bogus studies and articles by people who could actually CITE their proof, he and his cronies cry foul? I say let the chips and the names fall where they may.

I have a name for someone who presents false studies and journal articles that could hurt people...yes, these studies involve more than data on a computer screen, they involve real human beings and these people can be hurt; and that name is much more accurate and less polite than "bling-bling" GET OVER IT.

(yes, I know that was a run-on sentence; but I'm pissed off at a bunch of chicken shits who'd rather make nice than actually do some good.)Sickening.

An anonymous reader sent me the following, which is reproduced below verbatim:

"Dr. Nemeroff often cries “character assassination,” but he has shown no compunction in making gratuitous, ad hominem attacks on others (see, for example, letters-to-editor replies he has authored over the years). Your readers can infer from the data cited in this blog and elsewhere the level of Dr. Nemeroff’s scientific credibility. No external character assassination is needed."

Well, it seems like my unscientific survey has rendered a clear verdict! To summarize, y'all think I should stop being so sensitive. I greatly appreciate your feedback. I'll write more about this when time allows. Feel free to keep adding comments if you'd like...

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About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...